Circannual variations in the international normalized ratio (INR) among mechanical heart valve surgery patients on life-long warfarin

Results: The median age of the patients was 49 (23– 78) years and the average heart rate during the CCTA scan was 62 ± 14 beats per minute. We found that the subjective image quality obtained with the guidance of the pre-selection of the scan protocol is better compared to the standard CCTA scanning, especially when the heart rate is more than 65 per minute (3.5 ± 0.5 vs. 2.8 ± 0.8; p = 0.06) respectively. The overall radiation dose was significantly lower in the pre-selection group compared to the standard CCTA (4.9 ± 1.4 vs. 7.5 ± 1.8 mSv; p <;0.01) respectively, The use of Prospective with padding or retrospective gating was infrequent in the nonenhanced scans based pre-selection of CCTA protocol compared to the standard group (14 out of 150 versus 28 out of 150 scans) respectively. Conclusion: The use of 256-raw CCTA and the determination of the acquisition protocol based on the assessment of the non-enhanced CT scan, prompts better image quality and a significant radiation exposure reduction. We recommend performing this analysis to guide the selection of the CCTA scan protocol. https://doi:10.1016/j.jsha.2018.05.005

Visual versus fully automated assessment of left ventricular ejection fraction M.D. Rami Abazid, Rami Abazid, Samah Abohamr, Osama Smettei, Mohammed Qasem, Anny Suresh, Mohammad Al Harbi, Abdulrahman Aljaber, Athary Al Motairy, Diana Albiela, Haitham Sakr

Introduction: The aim of this study is to compare three different methods commonly used in the assessment of left ventricle (LV) ejection fraction (EF) by echocardiography. Methodology: all patients underwent full echocardiography imaging that includes assessment of LVEF using M-mode, Automated EF (Auto-EF) through tracing the myocardial borders during systole and diastole, and visual EF estimation by two readers. Results: We enrolled 268 patients. Auto-EF measurement was feasible in 240 (89.5%) patients. The averaged LVEF was (52%12) with the visual assessment, (51%11) with Auto-EF and (57%13) with M-mode. Using Bland-Altman analysis we found that the difference between the mean visual and the Auto-EF was not significant [ 0.3% ( 0.5803–0.0053), p = 0.054]. However, we found a significant difference in the mean EF between the visual versus M-mode and Auto-EF versus M-mode with the mean differences: [ 2.4365( 2.9946–1.8783), p < 0.0001] and [ 2.1490 ( 2.7348–1.5631), p < 0.0001] respectively. Inter-observer variability analysis of the

ORAL ABSTRACTS FOR THE SHA29 MEETING

357

visual EF assessment between the two readers showed that intraclass correlation coefficient was 0.953, (95% confidence interval: 0.939–0.965, p < 0.0001), with excellent correlation between the two readers: R = 0.911, p < 0.0001). Conclusion: The two-dimensional echocardiographic methods using Biplane Auto-EF or visual assessment were significantly comparable, whereas M-mode results in an overestimation of the LV ejection fraction. https://doi:10.1016/j.jsha.2018.05.006

Circannual variations in the international normalized ratio (INR) among mechanical heart valve surgery patients on life-long warfarin Samir Alshnaikat, Reem Sirriyeh, Fadi Obeid, Refaei Samiah, Iyad Farah, Mukhtar Abdelmajid, Mohammed Abdelshafy, Ahmed Saileek Introduction: The aim of our study was to explore if there exists a circannual rhythm in INR as fluctuations in anti-coagulation can have serious consequences in patients with mechanical heart valve prosthesis. Methodology: This is a retrospective study performed in patients with stable INR value for at least 30 days post heart valve surgery in the period 2015–2016 attending a nurse-managed, cardiologist-supervised anti-coagulation clinic at King Abdul Aziz Cardiac Center.we determined average seasonal INR values for each patient, separately for aortic and mitral valve replacement patients. Data were analyzed using JMP Version 7.1, p < 0.05 considered significant. Results are expressed as mean ± SEM, differences between means were analyzed using Wilcoxon-rank sums test and chi-square as appropriate. Seasonal changes in INR were analyzed using analysis of variance of repeated measures (MANOVA), adjusting for potential confounders. Results: Data Collected for 397 patients (mean age 50 ± 0.7 years, 56% male) with a total of 6,220 INRs; 4149 in the high target (2.5–3.5) and 2021 in the low target (2–3) patients. There was no significant difference in the number of INR determinations performed across seasons. INR decreased significantly with time, from the highest value in the summer at 2.8 ± 0.07 to lowest in winter at 2.6 ± 0.02 (p < 0.0001), irrespective of the target INR (p = 0.36). There was no significant interaction between time-related changes in INR and age, gender, INR target, renal impairment, concomitant anti-platelet treatment except for smoking, which showed a significant interaction with INR variation over time (p < 0.001). Conclusion: To the best of our knowledge. This is the first study in the Middle-East extending European and North-American data on circannual changes in INR. Our results confirm the existence of such a rhythm; however the mechanism is unknown. Our findings

ABSTRACTS

J Saudi Heart Assoc 2018;30:356–369

358

ORAL ABSTRACTS FOR THE SHA29 MEETING

ABSTRACTS

recognize winter as a challenging season for maintaining optimum anti-coagulation, possibly requiring higher number of outpatient visits and INR determinations, with implications for health care costs.

J Saudi Heart Assoc 2018;30:356–369

Assessment of optimization of chronic heart failure medications and its effect on readmission rate M.D. Khadiga Suliman, Bashier Osman

https://doi:10.1016/j.jsha.2018.05.007

Impact of ARNI (angiotensin receptor neprilysin inhibitor) on functional status of patients with heart failure and reduced ejection fraction (HFREF) M.D. Muhammad Soofi Introduction: Pharmacological measures have improved the survival and functional class among patients with heart failure. ARNI is the newest medication approved for patients with HFrEF and associated with significant improvement in survival and hospital readmissions. Functional activity can be assessed by NYHA class. Methodology: Retrospective analysis of the patients switched from ACEI/ARB to ARNI at King Fahad Medical City. Patients were regularly seen at the clinic after the initiation of ARNI. Symptoms, clinical examination and demographic and hemodynamic data were recorded at each visit along with modification and adjustment of medications. Their NYHA class were assessed before the initiation and recorded at each visit. Results: 82 patients were switched from ACEI/ARB to ARNI in last 1 year. 62% of patients were in NYHA class II and 38% of patients in NYHA III/IV. ARNI was stopped in 10 patients (7 patients due to kidney injury, hypotension and non-compliance and 3 patients expired with 15–20 days of initiation). Baseline characteristics were studied in 72 patients. Renal dysfunction was present at baseline in 35% of patients. Beta blockers were prescribed in 100% of patients (optimum dosage: 40%, 50%–<100% of optimum dosage: 44%, <50% of optimum dosage: 15%). MRA was prescribed in 54% of patients. Follow up completed for 60 patients. ARNI was titrated to optimum dosage in 58% of patients. No mortality recorded in the long term follow up. Drop in systolic BP were recorded in 58% of patients (maximum drop was of 42 mmHg and average was 19 mmHg). No worsening of renal function was noted in 42% of patients. NYHA class improved in 68% of patients (NYHA III to II: 30%, NYHA II/III to I: 38%). Conclusion: ARNI was tolerated in 88% of patients when switched from ACEI/ARB and was associated with significant improvement in NYHA class in 68% of patients. https://doi:10.1016/j.jsha.2018.05.008

Introduction: Heart failure is a progressive disease associated with recurrent hospital admissions, although guidelines recommend the use of evidence based medications with optimal doses to reduce readmission rate, but many surveys found that the optimization of heart failure medications in clinical practice is sub optimal. Methodology: Eighty-one patients with heart failure with reduced ejection fraction who were admitted to one of the teaching hospitals in Sudan from March 2016 to May 2016 have been included, optimization of their chronic heart failure medications was assessed and according to that patients have been ordered to three levels of medications optimization, then the readmission rate between the levels was compared by using Kruskal– Wallis test when the comparison was between more than two groups otherwise, Mann-Whitney Test was used, the above 2 tests were used based on Shapiro-Wilk normality test which has shown that readmission rate was continuous skewed data, significant level was set at 0.05, analysis was performed with Statistical Package for Social Sciences (SPSS) software version 23. Results: Five percent of those who prescribed Beta blockers were achieved their target doses, while all the patients who were on Mineralocorticoid receptor antagonists achieved the lower range of their target doses. On the other hand only 3.4% among those who were prescribed Angiotensin Converting Enzyme Inhibitors achieved their target doses. Patients who prescribed all evidence based medications and achieved their target doses were only 4.9% and this group of patients has shown the lowest readmission rate. Conclusion: This study concluded that the dose optimization of recommended heart failure medications was extremely sub optimal and the optimization of medications significantly affects the readmission rate. https://doi:10.1016/j.jsha.2018.05.009

Clinical characteristics and outcome of hypertrophic cardiomyopathy in the Saudi population – A single cardiac center experience Sara Saleh Aldwailah, Dikra Al-Dobai, Deema Alduaiji, Shatha Naser Almutari, Azra Mahmud, Mohammad AlGhamdi Introduction: Hypertrophic Cardiomyopathy (HCM), a relatively uncommon entity, is the most